Consumers Diagnose The State Of Their Healthcare; New Report By California Health Decisions Inc. Reveals Patient, Doctor Views of Managed Care, Offers Improvement Solutions.

ORANGE, Calif.--(BW HealthWire)--Oct. 2, 1998--In a new report issued Friday by California Health Decisions Inc. (CHD), consumers and physicians offer their own diagnoses on the managed healthcare they experience.

After four years of focus group research, CHD, a nonprofit organization dedicated to involving the public in health choices, has published Public Values and Perspectives on Managed Care, a comprehensive report that examines the views of health plan members and their physicians on their managed care. The report, which was funded by the Integrated Healthcare Association (IHA), is based on in-depth focus group discussions and telephone interviews with approximately 1,000 health plan members and 100 physicians in northern and southern California.

The research began as part of a larger healthcare improvement program based on CHD's Consumer Feedback Loop(SM), a process that brings patients, providers, purchasers and health plans together to talk about the issues and bring about change.

"The integration of all these parties -- particularly the inclusion of patients -- offers a unique opportunity to identify the real hopes and concerns consumers have and make improvements that respond to those concerns," said Ellen B. Severoni, president of CHD. "Our Consumer Feedback Loop partners enter into the projects with a commitment to change, and many solutions have already emerged from their work."

RESEARCH FINDINGS

The research findings show that the same issues cut across cultural, educational, age and other demographic boundaries, and they tend to relate more to the process of obtaining healthcare than to the quality of care delivered.

Referrals and authorizations to see a specialist or receive certain treatments were cited most frequently as troublesome areas. A third of the respondents reported having referral or authorization problems in the past year. Many say they have to wait too long for authorization decisions; others do not understand how the processes work and believe no one is doing a good job of informing them.

Many consumers also perceive that the traditionally close relationship between doctors and patients is deteriorating as a result of managed care, citing long waits to see a doctor and little time once they are in the office.

Respondents are consistent in noting other problems: frustration and anger when their prescription drug coverage is changed; confusion about procedures and policies related to emergency room usage, and poor understanding about how to resolve problems. The concept of fairness frequently arises, particularly when consumers perceive that cost counts for too much in decisions about their care.

While more than two thirds of the respondents said they were "very" or "somewhat" satisfied with their healthcare, the dual purpose of this research was to identify the problems that exist and to suggest possible solutions. One solution that is already succeeding is a guaranteed one-call system for resolving billing issues, developed jointly by Health Net and Hill Physicians Medical Group.

Now, consumers who have a question about their billing can make a single call, to either organization, and one individual will take responsibility for resolving it. Another example is an educational program to help pharmacies understand the impact that changes in prescription drug coverage have on consumers, developed jointly by the Alameda Alliance for Health and Community Health Center.

CHD did not start out with the idea of publishing a report; however it soon became clear that the cumulative research data would be of great value to anyone interested in improving healthcare, according to Severoni. "It is our hope that other healthcare organizations and purchasers will pay close attention to what patients are saying," she said. "Addressing these critical issues can go a long way toward solving the problems that plague our healthcare system."

"We at CalPERS are delighted that our search for easier and more cost-effective ways to provide access to medical specialists has played a major role in this pioneering CHD report on managed care," said Dr. William Crist, president of the CalPERS Board of Administration. "This is one of the first studies of its type to bring the consumers of healthcare direct to the table with employers, medical providers and health plans. We see it as a major step in resolving some of the biggest issues surrounding managed care."

The research for this report was conducted for CHD by the research firm Lake Snell Perry & Associates over a period of four years. Focus groups were held in northern and southern California and included members from diverse backgrounds in both the private and public sectors. For a free copy of the executive summary or a copy of the full report ($50), contact CHD at 505 South Main Street, Ste. 400, Orange, Calif. 92868, or visit www.cahd.org.

CONSUMER FEEDBACK LOOP PROJECT PARTICIPANTS

Many organizations and individuals participated in the Consumer Feedback Loop projects that resulted in this research.

Four California Healthcare Purchasers:

-- CalPERS (California Public Employees' Retirement System)

(Sacramento)

-- Chevron Corporation (San Francisco)

-- St. Joseph Health System (Orange)

-- State of California, Department of Health Services 

(Sacramento) for the Medi-Cal population in Alameda County

Four Health Plans:

-- Alameda Alliance for Health

-- Blue Cross of California

-- Health Net

-- PacifiCare of California

Twelve Healthcare Provider Organizations:

-- Alameda County Ambulatory Health Care Services

-- Alta Bates Medical Group

-- Children First Healthcare Network

-- Community Health Center Network

-- Hill Physicians Medical Group Inc.

-- Howard Daniel, M.D.

-- MedPartners, Inc.

-- Michael LeNoir, M.D.

-- Orange Coast Managed Care Services

-- St. Rose Hospital

-- Scripps Medical Associates

-- Summit Medical Center

Nine health plan members who are associated with participating purchasers and receive their healthcare through participating physician organizations also participated.

Funding for the projects and this research was provided in part by CalPERS, Health Net, Hill Physicians Medical Group Inc., PacifiCare, Parke Davis, St. Joseph Health System Foundation, The California Wellness Foundation, The James Irvine Foundation, and The Medical Quality Commission.